Tug of War in the Health Care Sector

Tug of War in the Health Care Sector

„Quality has its price“: The motto of this year's event underlines once again the demands of hospital staff who had taken to the streets at the end of September with whistles and posters. Money for hospitals is lacking, hospital staff criticise the planned reforms of the German federal health minister Ulla Schmidt. Hospital shutdowns and job cuts are the inevitable result, so they argue.

The financial support of 3.2 billion Euros planned by the minister is for two reasons not enough, says the speaker of the German Hospital Conference Association (Deutsche Krankenhausgesellschaft, DKG) Holger Mages. On the one hand, the risen wages and energy costs tear a hole of 6.4 billion Euros until the end of 2009. „On the other hand, the promised three billion subsidies are not three billion in reality: almost half of the money corresponds to the budget rise which the hospitals would have gotten anyway“, Mages argues.

Criticism and counterarguments

One of the much discussed disputes: how many beds does a country need? According to Eurostat, 406 beds for medical treatment came on 100,000 inhabitants of a country in EU average in 2005. Germany headed with 635 beds per 100,000 inhabitants. Sweden was the tail-ender with 218 beds per 100,000 inhabitants. „The consumer advice centre in particular comes forward with criticism, the hospital beds were not used to capacity. However, the extent of utilisation is very high“, Mages explains. „From 1990 to 2006, 343 hospitals were closed and 170,000 beds diminished. The length of stay in the hospital has shortened from 15 to eight days. However, the number of patients has risen by 1.5 millions.“ There is no scope for shortenings any more, he concludes.

A study of the Rhenish-Westphalian Institute of Economic Research (Rheinisch-Westfälischen Instituts für Wirtschaftsforschung, RWI) on the other hand concluded that the medical centres could work more economically by optimising processes – many duties of the doctors could be carried out, for example, by cheaper nursing staff. „The hospitals have already advanced their cost effectiveness, by outsourcing, for example, and improved work flow. However, savings by structural improvements cannot offset the risen personnel and material costs“, Mages says. „Ten to eleven percent of the hospitals have already concluded emergency wage agreements, that means the employees must renounce holiday or Christmas allowances to compensate for the economic situation.“

"Investment backlog of 50 billion Euros"

Money is scarce everywhere and each party wants to get its share: a big tug of war has long begun. The rates for the health insurance contributions were just fixed by politicians. For most insured persons this means a rise of their contribution. Too low, the health insurance companies complain anyway; since these in turn have to finance the operating expenses of the hospitals.

Also the federal states are involved in the financing: they provide the investment money for modern devices and hospital buildings. „However, the countries do not pay what they should“, Mages complains. „In the meantime, there is an investment backlog of 50 billion Euros. The countries must increasingly attend to their duty again.“

Mages stresses: „A secure financial basis is important for the hospitals to carry out further planned reforms like the nationwide standardisation of the case based lump sum.“ At the moment the lump sums that are paid per disease diagnosis and patient differ according to federal state. However, this is to be adapted in 2009.

One of the guests invited to the discussion panel about financing and reforms on the opening day is Ulla Schmidt. „If she comes, it will be made clear that we do not accept the situation uncontradicted“, says Mages. So it promises to get exciting, on the 31st German Hospital Conference.

An overview on all events of the 31st German Hospital Conference and the MEDICA Congress is available here